Provider Demographics
NPI:1437208550
Name:LALEZARIAN, KHOSROW K (DMD)
Entity Type:Individual
Prefix:DR
First Name:KHOSROW
Middle Name:K
Last Name:LALEZARIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N CAMDEN DR
Mailing Address - Street 2:SUITE 626
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4532
Mailing Address - Country:US
Mailing Address - Phone:310-275-0838
Mailing Address - Fax:310-275-0106
Practice Address - Street 1:414 N CAMDEN DR
Practice Address - Street 2:SUITE 626
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4532
Practice Address - Country:US
Practice Address - Phone:310-275-0838
Practice Address - Fax:310-275-0106
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice